PREVENTING RELAPSE IN PEOPLE WITH BIPOLAR DISORDER

A systematic review and economic model of the clinical effectiveness and cost-effectiveness of interventions for preventing relapse in people with bipolar disorder

Background

Bipolar or manic-depressive disorder is a frequent, severe, mostly recurrent mood disorder associated with great morbidity and important mortality. The lifetime prevalence of bipolar disorder is 1.3 to 1.6%. The mortality rate of the disease is two to three times higher than that of the general population. Pharmacological and psycho-educational interventions have been used for the prevention of relapses in people with bipolar disorders. The effectiveness of such approaches, however, is still unclear. The aim of this project was to use systematic review and economic modelling to determine the clinical effectiveness and cost-effectiveness of pharmacological and psycho-educational interventions used for the prevention of relapse in people with bipolar disorders.

Findings

Lithium, valproate, lamotrigine and olanzapine are effective as maintenance therapy for the prevention of relapse in bipolar disorder. Olanzapine and lithium are efficacious for the prevention of manic relapses and valproate, lamotrigine and imipramine for the prevention of depressive relapse. Carbamazepine is not an effective maintenance treatment. There is no trial evidence for the efficacy of combination therapy. Psychosocial therapies have not been investigated thoroughly. There is some evidence that CBT, group psychoeducation and family therapy might be beneficial as adjuncts to pharmacological maintenance treatments. There is insufficient information to permit any meaningful assessment of the relative tolerability of the treatments or their relative effects on suicide rate and mortality. For patients with a recent depressive episode, valproate, lithium monotherapy and the combination of lithium and imipramine are potentially cost-effective. For patients with a recent manic episode, olanzapine and lithium monotherapy are potentially cost-effective. The cost-effectiveness estimates in both groups of patients were shown to be sensitive to the assumption of a reduced suicidal risk associated with lithium-based strategies.

Conducted by: K Soares-Weiser1, Y Bravo Vergel2, S Beynon1, G Dunn2, M Barbieri3, S Duffy1, J Geddes4, S Gilbody5, S Palmer2, N Woolacott1

1. Centre for Reviews and Dissemination; 2. Centre for Health Economics; 3. The Economic and Health Research Centre, Universitat Pompeu Fabra; 4. Department of Psychiatry, University of Oxford; 5. Department of Health Sciences, University of York

Further details

Project page on the NIHR HTA Programme website

Publications

Soares-Weiser K, Bravo Vergel Y, Beynon S, Dunn G, Barbieri M, Duffy S, Geddes J, Gilbody S, Palmer S, Woolacott N. A systematic review and economic model of the clinical effectiveness and cost-effectiveness of interventions for preventing relapse in people with bipolar disorder. Health Technol Assess. 2007;11(39):1-226

Beynon S, Soares-Weiser K, Woolacott N, Duffy S, Geddes JR. Pharmacological interventions for the prevention of relapse in bipolar disorder: a systematic review of controlled trials. J Psychopharmacol. 2009;23(5):574-91

Beynon S, Soares-Weiser K, Woolacott N, Duffy S, Geddes JR. Psychosocial interventions for the prevention of relapse in bipolar disorder: systematic review of controlled trials. Br J Psychiatry. 2008;192(1): 5-11

Posters

Woolacott N, Soares-Weiser K, Beynon S, Duffy S, Geddes J. Pharmacological interventions for the prevention of relapse in bipolar disorder: a systematic review of controlled trials. HTAi Annual Meeting 2007. Barcelona, Spain, 17 June 2007

Funding

Commissioned by the HTA Programme on behalf of NICE's Technology Assessment Report (TAR) process